Retired Docs Come to the Aid of Rural Health Clinics

Olivia Basurto was concerned when her nine-year-old son Samuel came home from school with a rash on his arms. After trying to treat the pink bumps with over-the-counter creams, and having no success, Basurto called to make an appointment with a dermatologist.

She quickly learned that in her small rural town of Pixley (population 3,310), in the Central Valley, physician specialists are a rare commodity. The nearest specialist was either in Porterville or Fresno, located almost an hour away, and they had a three-month wait.

But then, the Pixley Medical Clinic, a rural health clinic that provides family practice medicine to residents of Pixley and the surrounding cities, asked Basurto if she would be open to a telemedicine appointment with a dermatologist. The doctor, a retired dermatologist volunteer with The MAVEN Project, could assess her son’s rash and offer medical advice.

Laurie Green, a San Francisco obstetrician-gynecologist, decided in 2014 to launch the MAVEN (Medical Alumni Volunteer Expert Network) Project, as a way of addressing the nation’s physician shortage, especially in rural areas. The Project, which currently operates in California, Massachusetts and Florida, with plans to expand nationally, is composed of volunteer retired physicians who use telemedicine to offer specialty consults to patients, and guidance and support to community health providers, especially new physicians, physician assistants and nurse practitioners.

The physician shortage will only worsen in the years to come, Green said, adding that rural areas such as Pixley will be hit the hardest. A 2016 physician workforce report released last April by the Association of American Medical Colleges (AAMC), found the U.S. will experience a significant physician shortage over the next decade. By 2025, the study estimates a shortfall of between 14,900 and 35,600 primary care physicians and a shortfall of between 37,400 and 60,300 physician specialists.

A Merritt Hawkins survey found that wait times for doctor appointments have increased by 30 percent since 2014, in part due to the physician shortage and the growing number of insured patients under the Affordable Care Act (ACA).

“Few doctors in the state accept new Medi-Cal patients, and there remain many individuals who despite exchange products cannot afford coverage,” Green said. “The sheer size of California makes certain geographies difficult to reach, and large areas of Eastern California lack local primary care and specialty physicians.”

When patients in rural areas become ill, Green said, they often seek care at either hospital emergency rooms or the community health centers in their locale, most of which are staffed by mid-level practitioners.

“Given the difficulty many patients have finding the time and resources to visit a clinic, it is critical that each encounter results in a diagnosis and care plan,” Green said. “By providing immediate, free consultations by high quality medical specialists, the MAVEN Project fills this need. Telehealth makes geographic distances irrelevant.”

Individualized Care from Experienced Retired Physicians

In Basurto’s case, she and her son were given a telehealth appointment with one of the MAVEN Project’s doctors, a retired dermatologist. A nurse practitioner sat with Basurto and her son in the Pixley medical clinic, while the physician from the MAVEN Project assessed her son’s rash via camera.

“The doctor determined my son had molluscum, (a viral skin infection that results in round, painless bumps),” Basurto says. “I was given a prescription to treat my son and the doctor was great about answering all of my questions.”

Basurto also received a telehealth consult for her son, Daniel, 2, who suffered from eczema, an itchy inflammation of the skin.

“The OTC cream I was using on Daniel wasn’t helping and he was very uncomfortable,” Basurto says. “The doctor gave me a prescription for an ointment that really helped him to feel better.”

Linda Roberts, a registered nurse and CEO of the Pixley Medical Clinic, said the MAVEN physician who volunteer with her clinic conducts telehealth visits with 25 patients each month and helps her clinic meet the high demand of patients who need dermatology services.

“We have a high Latino population here in our area and many of our patients work outdoors which can put them at risk for developing skin cancer,” Roberts said. “The MAVEN physician who works with us is very knowledgeable and can determine if a patient’s mole or lesion looks suspicious and may warrant a biopsy.”

Early detection is important as noted by a 2016 study published in the Journal of Skin Cancer, that found while non-Hispanic whites have the highest incidence of melanoma, the deadliest form of skin cancer, Hispanics are typically diagnosed at later disease stages and suffer higher mortality.

In addition to providing specialist care to community health clinics, Green noted the MAVEN Project also provides a volunteer and social outlet for retired and semi-retired physicians who want to continue providing patient care without handling the business side of medicine.

“Our inaugural group of volunteers were culled from UCSF, UCLA and Stanford medical school alumni groups,” Green said. “We are particularly interested in addressing the need in the Imperial and Central Valleys.”

Debra Cohen, a semi-retired pediatric endocrinologist from Santa Clara, Calif., joined the Maven Project two years ago as a volunteer and provides remote consults to juvenile diabetes patients who live in California. She currently volunteers eight to10 hours each month, but hopes to take on more hours.

“The Maven project is one of the most efficient and well-organized non-profits I’ve ever worked with,” Cohen said. “From ensuring that volunteer doctors are covered by malpractice insurance, to matching physicians with a clinic, to training us on how to use telemedicine equipment that is compliant with patient protection laws, they make it a seamless process.”

Cohen works with community health clinics within the state to address problems their pediatric patients might be having with blood sugar and diabetes-related complications.

“Prior to learning about the MAVEN Project, the only volunteer work I knew of for physicians was serving overseas on medical missions,” Cohen said. “With The MAVEN Project, physicians receive flexible schedules and can work from their own homes.”